Individual
JOHN KODOSKY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
4502 MEDICAL DR FL 2, SAN ANTONIO, TX 78229-4402
(210) 358-0265
(210) 358-8451
Mailing address
4502 MEDICAL DR FL 2, SAN ANTONIO, TX 78229-4402
(210) 358-0265
(210) 358-8451
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
PA03059
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
192249402
—
TX
01
—
192249403
CSHCN
TX
Enumeration date
08/24/2006
Last updated
03/05/2019
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